Endometriosis, a common cause of pelvic pain, affects approximately 10% of reproductive-age females. Author Sawsan As-Sanie, MD, MPH, University of Michigan, discusses the epidemiology, pathophysiology, diagnosis, and treatment of endometriosis with JAMA Senior Editor Karen E. Lasser, MD, MPH.
Endometrial cancer accounts for 95% of uterine cancers, which are the fourth most common cancer in women in the US.1 Approximately 1 in 32 women in the US will develop endometrial cancer in their lifetimes. Eighty percent of endometrial cancer cases in the US are diagnosed in postmenopausal women, and the average age at diagnosis is 60 years. However, rates of endometrial cancer are increasing in both older and younger women in the US and worldwide.
A leading risk factor for endometrial cancer is obesity. Other common risk factors are diabetes and a personal or family history of inherited conditions such as Lynch syndrome (a genetic disorder that increases the risk of multiple types of cancer). Additional risk factors include use of estrogen without progesterone, tamoxifen (a medication to treat or prevent hormone receptor–positive breast cancer), and having never been pregnant. In contrast, combined oral contraceptives and progesterone therapy, including progesterone-releasing intrauterine devices, are associated with a decreased risk of endometrial cancer.
Endometriosis is a chronic condition defined by the presence of endometrial-like tissue outside of the uterus, which can lead to estrogen-driven inflammation. The extent of disease can be highly variable, ranging from minimal peritoneal deposits to deep disease that can invade into the bowel, bladder and ureter and, more rarely, spread to extrapelvic (e.g., cutaneous, thoracic) sites. Endometriosis is a complex disease that has considerable impact on the quality of life of those affected and that has no cure. It remains poorly understood. We review the epidemiology, pathophysiology, diagnosis and management of endometriosis, based on the best available evidence and clinical guidelines
Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
